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MAGNOLIA DERMATOLOGY, PLLC

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Company Details

Name: MAGNOLIA DERMATOLOGY, PLLC
Jurisdiction: New York
Legal type: DOMESTIC PROFESSIONAL SERVICE LIMITED LIABILITY COMPANY
Status: Active
Date of registration: 20 Jun 2023 (2 years ago)
Entity Number: 6881529
ZIP code: 12211
County: Albany
Place of Formation: New York
Address: 1 LOUDON HTS S, LOUDONVILLE, NY, United States, 12211

DOS Process Agent

Name Role Address
THE LLC DOS Process Agent 1 LOUDON HTS S, LOUDONVILLE, NY, United States, 12211

Unique Entity ID

Unique Entity ID:
E219WKYK6FG3
UEI Expiration Date:
2026-01-14

Business Information

Division Name:
MAGNOLIA DERMATOLOGY
Activation Date:
2025-01-16
Initial Registration Date:
2024-03-04

National Provider Identifier

NPI Number:
1932889102
Certification Date:
2024-05-13

Authorized Person:

Name:
DR. VIRGINIA TRACEY
Role:
MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

History

Start date End date Type Value
2023-06-21 2023-08-22 Address 1 loudon hts s, loudonville, NY, 12211, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
230822004298 2023-08-22 CERTIFICATE OF PUBLICATION 2023-08-22
230621000889 2023-06-20 ARTICLES OF ORGANIZATION 2023-06-20

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Date of last update: 20 Mar 2025

Sources: New York Secretary of State